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ID 2 USMLE

ID USMLE2

QuestionAnswer
TB treatment RIPE-rifampin, INH, pyrazinamide, ethambutol + B6 w INH to prevent peripheral neuritis
cut-offs for PPD + 5mm if HIV, close TB contacts, CXR evidence of TB; 10 indigent/homeless, IV drug, chronic illness, health care workers, inmates, residents of developing nations; 15 everyone else
complications assoc w TB meds rifampin=body fluids orange; ethambutol=optic neuritis, red-green color blind; INH=peripheral neuritis and hepatitis
how active TB diagnosed sputum acid fast stain (take 3 a.m. samples)
what is prophylactic TB therapy INHx9mo (for PPD conversion w/o active symptoms, CXR suggests old TB)
what vaccine makes PPD+ BCG vaccine
standard treatment for malaria oral chloroquine--but increasing resistance, so now also add primaquine
how difft Strep and Staph Strep catalase - chains, Staph catalase + clusters
how difft subtypes of Staph all catalase +, coag +, b hemo = S Aureus; coag - novobiocin sensitive= S epidermis; coag - novobiocin resistant= S sapro
how difft subtypes of Strep all catalase -, then subdivide by hemolysis: alpha=pneu, viridian; beta=GrpA (pyo), GrpB (aglact); gamma=Enterococc
what do alpha, beta, gamma hemolysis for strep mean in culture? alpha=green partial hemolysis; beta=clear, complete hemo; gamma=no hemo
+ Quellung test indicates what S pneu (its capsule)
name some gram + rods Clostridium (anaerobe, spore), Listeria (milk, meningitis in baby), bacillus (aerobe, spore)
beta hemo, Grp A Strep is which organism S Pyo
how difft alpha hemo Streps? optochin sensitive, bile soluble=S Pneu; optochin resistant, bile insoluble=viridians (no capsule)
name some gram - cocci/coccoid rdos cocci=Neisseria, coccoid=H flu, Pasteurella, Brucella, Bordetella
gram - non cocci/non rods spirochetes=H pylori, borrelia; comma=vibrio, Camp Jej; safety pin=yersinia; branch=Nocardia
gram - rods aerobic Pseudo, Legionella, Bordetella, Brucella
gram - rods facult anaerobic Enterobac, Pasteurella, H Flu, Vibrio
subdivide gram neg rods based on lactose ferment lactose ferment [LEEK]=Klebsiella, E coli, Enterobac; non fermenter [SSPP]= Shigella, Salmonella, Proteus (oxidase -); Pseudo (oxidase +)
subdivide gram neg rod non lactose ferment Shigella, Salmonella, Proteus (oxidase -); Pseudo (oxidase +)
obligate anaerobe bac Clostridium, Actinomyces, Bacteroides
clinical presentation PCP severe hypoxia with normal CXR or diffuse, bilateral interstitial infiltrates and dry cough **esp suspect in HIV w PNA
classic triad of Strep pharyngitis? Centor criteria (4)? fever, exudative pharyngitis, cervical lymphadenopathy (w/o cough)--the Centor criteria includes 4: errhythematous and exudative pharyngitis, cervical lymphadenopathy, w/o cough
characteristics of rheum F No rheum for SPECC: subQ nodules, polyarthritis, eythema marginatum, chorea, carditis
Strep B causes PNA, meningitis, sepsis mainly in babies
lab test indicates recent Strep pyo infx ASO titer
symptoms not indicating Strep pyo pharyngitis cough, hoarseness, GI, conjunctivitis
characteristics of scarlet F sandpaper-like rash on trunk, strawberry tongue; rash desquamates after few days
difft bw Janeway lesions and Osler nodes Osler's painful and raised on finger pads, Janeway errhyth and on palm or sole--both endocarditis
adenovirus causes pharyngitis, PNA, pink eye
besides adenovirus, what other organisms cause pharyngitis-like illnesses Hflu=epiglottitis, parainflu=croup, C Diphth=pseudo mem pharyngitis, Strep pyo=pharyngitis and rheum F
parvo causes slapped cheek (erythema infectosium), hydrops fetalis, plastic crisis in sickle cell
papilloma causes HPV warts CIN, cervical cancer
poxvirus causes small pox, molluscum (think HIV)
list various Herpes virus HSV1,2, varicella, EBV, CMV, HHV6,8
HSV1,2 cause HSV1-oral, HSV2 genital
varicella causes chicken pox, zoster, shingles
EBV causes mono, Burkitt lymph
CMV causes various dz in immunosuppresses
congenital CMV causes petechial rash, periventricular Ca++, (MC congenital infxn)
HHV6 causes roseola-very hi fever, stops and then rash
HHV8 causes Kaposi's sarcoma in HIV
Tzanck smear is used to ID HSV and VZV
tx CMV ganciclovir
tx HSV acyclovir (also for EBV tx)
name DNA viruses adeno, parvo, papillo, pox, various Herpes
dog/cat bite assoc with infxn? Pasteurella
cat assoc with infxn? Toxo
cat scratch assoc with infxn bartonella henslea
thorn assoc w infxn sporothrix schenke
sheep assoc w infxn anthrax
crypto assoc w environ causes soil, pigeon droppings
Histo assoc w bird/bat, Missi/Ohio, caves
Cocci assoc w SW US/CA
Paracocci assoc w S America
systemic mycoses (4) Histo, Blasto, Cocci, Paracocci
tx for systemic mycoses local infxn: flucanozole, ketoconazole; systemic: amphotericin B
opport infxns candida, PCP, systemic mycoses, aspergill, crypto
describe mycoplasm PNA walking PNA chest xray looks much worse than pt, incrsd cold agglutin (IgM) **don't give PCN bc no cell wall
pericarditis caused by coxsackie A, B, TB
myocarditis caused by coxsackie B, Lyme, Chagas, SLE
subacute endocarditis caused by strep viridans
acute bac endocarditis caused by Staph aureus
findings RMSF rash starting on palms, decrsd plts, proteinuria, hematuria
list Rickettsi type dz typhus, prowazeki, Ehrlichia, Q fever (Coxiella burnetti)
what organism for Q fever coxielli burnetti
why Q fever unique no rash, no fever, negative Weill Felix, not Rickettsi genus
what's Weill Felix rxn Ab cross reacts with Proteus (which is an UTI bug in hospitals); all the Rickettsia bugs except Q fever are positive for this
which Rickettsi is fleas? Lice? fleas=R typhi (endemic), lice=prowazeki (epidemic)
dzs passed by tick Lyme (Borrelia burgdorfei), Ehrlichia, tularemia, plague (yersinia pestis), epidemic typhus (Ricket. Prowazeki)
what organism for Lyme dz Borrelia burgdorfei
describe typhus rash begins on trunk and spreads out (v RMSF)
what's 5th dz? Name, Symptoms and organism erythema infectiosum (slapped-cheek--starts on cheek and proceeds to trunk and extremities) ((caused by parvovirus B19))
scarlet fever sandpaper-like rash on trunk, strawberry tongue; rash desquamates after few days
dzs can cause rash on palms, soles RMSF, syphillis, coxsackie A (hand, foot, mouth dz), erythema multiforme
what are the dermatophytes? microsporum, trichophyton, epidemiophyton
what dzs do dermatophytes cause? tineas pedis and cruris (athlete's foot and jock's itch), tinea corporis, tinea capitis (ringworm, scalp caling)
how identify dermatophytes? KOH preparation
what organism causes tinea versicolor? pityrosporum orbiculare (yeast)
signs/symptoms rubeola 3c's: cough, coryza, conjunctivitis, Koplik spots, rash head to toe spread
what are the paramyxo viruses? (PRM) parainfluenza, rubeola (measles), RSV
what virus family are german measles under? togavirus
signs/symptoms rubella generally same as rubeola except more mild, also suboccip and postauricul nodes tneder, rash more faint head to toe and encephalitis also a potl complication
what are complications of rubeola encephalitis and giant cell PNA
what's the tx for RSV ribavirin
India ink prep on CSF from HIV pt would mean Crypto
what Rx given at what CD4 count for HIV/AIDs <500: HAART, <200: PCP Rx (bactrim, same Rx as for Toxo which at risk <100), <100: Mycobac (clarithromycin, erythromycin)
what Rx for PCP? If allergies? trimethoprim-sulfamethoxazole (Bactrim); if allergy: dapsone and pentamidine
when is a person diagnosed w AIDs if CD4<200, if opportunistic infxn
Ring enhancing cerebral lesions in HIV pt usu Toxo, or primary brain lymphoma
yrly what should HIV pts get? Overall what vaccines? PPD, Flu vaccine (+ other vaccines Pneu, Hep, inactive polio vaccine, MMR **only live vaccine they should get)
HIV pts at risk for what blood cancer non hodgkins lymphoma
pregnant women w HIV they and their babies should take AZT (zidovudine), mom's can't breast feed, positive HIV test on infant <6mo is unreliable (could be mom's Abs)
how detect PCP path Silver (Wright-Giemsa or Giemsa)
retinitis in HIV due to? Treatment? CMV, treatment ganciclovir/valganciclovir (back up is foscarnet)
at what CD4 count is pt at risk for Toxo? Myco? PCP? Toxo <100, PCP<200, Myco <100
Created by: ehstephns on 2010-12-10



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